Care Manager, RN Job Description
Care Manager, RN Duties & Responsibilities
To write an effective care manager, RN job description, begin by listing detailed duties, responsibilities and expectations. We have included care manager, RN job description templates that you can modify and use.
Sample responsibilities for this position include:
Care Manager, RN Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Care Manager, RN
List any licenses or certifications required by the position: CCM, ABQAURP, ACM, BLS, PALS, HCP, PRI, ACLS, BCLS, CPR
Education for Care Manager, RN
Typically a job would require a certain level of education.
Employers hiring for the care manager, RN job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Education, Science, Graduate, School of Nursing, Healthcare, Nursing Program, Social Work, Management, Social Sciences
Skills for Care Manager, RN
Desired skills for care manager, RN include:
Desired experience for care manager, RN includes:
Care Manager, RN Examples
Care Manager, RN Job Description
- Beginning the discharge planning coordination process upon admission or precertification
- Coordinating care with the member, family and care team as required
- Supervision of clinicians, support and administrative staff
- Conducting individualized clinical assessment
- Assisting in the development of new disease management and complex case management programs
- Creating and maintaining logs of caseloads for reporting and to monitor effectiveness of interventions
- Recommending, coordinating and educating providers on alternative care options
- Contributing to department goals and objectives in maintaining a high quality medical delivery system through the principles of quality improvement
- Collecting accurate and timely health care data and adequately documents patient related issues, (precert, concurrent review, alternative care, discharge planning, referrals), provider related issues and appropriate use of codes (ICD-9-CM and CPT Codes)
- Maintaining appropriate logs identified by the Medical Management Department and monitors weekly for quality assurance of data entry accuracy
- Preparing and presents Care Management and Utilization Statistics to appropriate Health Plan committees
- Working with Provider Relations Representatives by communicating office/provider concerns, needs and expectations
- Serving as a clinical liaison and educator to Health Homes and ADHC
- Refinement of policies, procedures and processes
- Participation in oversight of program protocols
- Train foster parents on relevant medical conditions, care instructions, proper use of durable equipment, medication regimens
Care Manager, RN Job Description
- Reporting critical incidents and information regarding quality of care issues
- Ensuring compliance with all State and Federal regulations and guidelines in day-to-day activities
- Participating in monthly chart audits
- Contribute to the development of patient-focused care and initiates the process in accordance with established guidelines
- Assess member's physical, psychosocial and discharge planning needs through communication with appropriate hospital staff, including Attending Practitioner, Utilization Review staff, Discharge Planners, and Social Workers
- Assist in identifying opportunities for and facilitating alternative care options based on member needs and assessments
- Evaluate and pre-authorize request for inpatient/outpatient, specialty care, home care, Durable Medical Equipment, and transportation services from network and out-of-network providers in accordance with departmental guidelines
- Document all interventions and telephone encounters with providers, members, and vendors in the appropriate system in accordance with established documentation standards to ensure integrity of member services provided over the continuum of care and over time
- Conducting a history and physical assessment re-assessments and other clinical assessments, as appropriate
- Assessing member / caregiver knowledge of necessary care needs, such as medication management, DME use and safety measures
- Collaborating with other team members and the member to establish a comprehensive care plan that identifies all needs
- Facilitating discharge planning, when necessary
- Documenting all findings and member related communications in database
- Ensuring compliance with care guidelines and protocols
- Coordinate care and ensure that members and their families receive the care they need
- Synthesize nursing assessment findings to determine members’ areas of risk needs
Care Manager, RN Job Description
- Participation.Actively participates in driving clinical and administrative compliance with care guidelines and core measures
- Competent professional practice and engaging in opportunities for professional growth
- Interviews patients and families to assess current functional status and support system
- Collaborates with the health care team to develop a plan of care by participating in patient care rounds
- Assures the discharge plan is in alignment with providing choice, assuring safety, and is timely and cost effective
- Assures the plan of care is individualized for patient's with a chronic disease to support patient/family self management following discharge
- Facilitates the safe transfer of patients to alternate level of care settings, assuring appropriate exchange of information among all caregivers
- Assists with scheduling discharges, pre planning discharges and identifying discharge goals during patient care rounds to assist with patient flow on the units
- Helps to identify strategies for reducing length of stay and appropriate utilization of services
- Utilizes criteria including clinical pathway data and implements strategies to resolve controllable variances
- Must contribute to the organization's goals and objectives and support the organizational strategic plans
- 5+ years of clinical experience in of the hospital’s service lines (SCI, Pediatric orthopedics, Burn care, Cleft lip and palate) preferred
- AZ State Licensed Registered Nurse
- Or case management
- Knowledge of utilization management procedures, mental health and substance abuse
- Discharge Planning background
Care Manager, RN Job Description
- Communicate with clients and multidisciplinary team by providing client related health information
- Applying care management standards and maintaining HIPAA standards and confidentiality of protected health information
- Understanding Clinical Impacts
- Providing Solutions to Constituent Needs
- Providing education to promote health engagement
- Working closely with members to implement an individual plan of care
- Makes skilled assessments of patients anticipated needs at discharge
- Communicates with patients and families about the case management process and about how this enhances the team plans for patients post-hospital care
- Acquaints customers with the functions of other members of the care management team who might also need to assess and assist patient/family
- Refers patients to other members of the care management team as appropriate (social worker, transportation or equipment coordinator)
- RN, Bachelors degree in Nursing/healthcare related field preferred
- One year of care management experience in a hospital setting
- 2+ years of prior Cse Management experience in a Hospital setting
- Discharge and Utilization Management experience in an Acute Care setting
- RN MN with MN Board of Nursing
- 1 to 3 years of work experience as an RN in a hospital setting required
Care Manager, RN Job Description
- Makes recommendations and take actions to improve structures, systems and outcomes
- Identifies and implements strategies to support Hospital and Departmental missions and priorities
- Uses evidence-based practice to initiate change and to drive improvement strategies
- Audit charts for compliance and participate in Quality Improvement activities
- Evaluation, supervision and development of Caregivers
- Evaluation & Care Management
- Combine clinical/quality considerations with regulatory/financial/utilization review demands
- Ensure patients are receiving excellent care
- Create a balance between individual clinical needs with cost effective utilization of resources
- Understand insurance and payment system regulations and requirements
- Must be a NYS licensed Registered Nurse
- Clean and active NYS RN license
- Computer literate in Care Management EMR
- Care Management certification preferred (CCM)
- Bachelor's degree from an accredited school of Nursiog preferred
- Valid RN license with the MN Board of Nursing